A Comparison Of Renal Function After Normothermic Cardiopulmonary Bypass And Hypothermic Cardiopulmonary Bypass In Children With Congenital Heart Disease

Objective: To investigate differences impact renal function after normothermic cardiopulmonary bypass and hypothermic cardiopulmonary bypass in children with congenital heart disease,understand the causes of the differences and identify which way is more favorable for children with congenital heart disease. Methods: A prospective, single-center, non-randomized controlled clinical trial was conducted in 147 cases of congenital heart disease children which diagnosed by echocardiography while accept cardiac surgery. They were taken into groups by a non-randomized control method.Children in Group normothermia(N=76) keep the temperature,crystalloid cardioplegia was perfused immediately after blocking the aorta to arrest the heart quickly.Children in Group hypothermic(N=71) do not cool until the start of CPB, other measures are the same as Group normothermia.. All children recorded gender, age, body weight, serum creatinine, urea nitrogen, the Cystatin C in the preoperative,while the lowest nasopharyngeal temperature, cardiopulmonary bypass time, aortic cross-clamping time and operation time were recorded as well. Take blood samples from those children at the end of CPB, 24 hours after CPB, 48 hours after CPB, 72 hours after CPB respectively and sent them to laboratory immediately. Results: Compared to hypothermic cardiopulmonary bypass,there were less AKI happened in Group normothermia, and the difference was statistically significant(P <0.05). The indicators including duration aorta clamping time, duration of operation time, age and the lowest nasopharyngeal temperature are different between the children were subjected to AKI after cardiac surgery and the children do not subjected to AKI after cardiac surgery,the differences were statistically significant(P <0.05). However there are no significantdifferences(P>0.05) in another indicators such as weight and duration of CPB time.Logistic regression analysis showed that some factors including duration aorta clamping time(OR=0.972) and age(OR=1.028)do not have much predictive value for AKI after cardiac surgery.Another factors including duration of operation time(OR=0.713) and the lowest nasopharyngeal temperature(OR=2.331) have much more predictive value. Conclusions: For children with congenital heart disease, normothermic cardiopulmonary bypass holds advantages in renal protection than traditional hypothermic cardiopulmonary bypass, the reason for this result due to normothermic cardiopulmonary bypass surgery need less aorta clamping time and operation time,as well as the higher nasopharyngeal temperature during surgery, but it still needs large sample studies to confirm.